U P DATE D I N F O RMATI O N F O R U S E RS O F F O R M W-8 B E N -E -
U S E O F F O RM W-8 B E N ( REVI S I O N DATE F E B R UA RY 2 0 0 6 )
B E F O R E JA N U A RY 1 , 2 0 1 5
T h e Fo rm W- 8 B E N - E refl ects ch a n g es m a d e by t h e Fo reig n Acco u nt Ta x C o m pl i a n ce Act
(FATCA) an d is fo r u se by b e n efic ia l own ers th at are e n ti ti es. E ntiti es a lso ma y u se the
F o rm W- 8 B E N (rev is i o n d ate F e b ru a ry 20 06) th ro u g h D e ce m be r 3 1 , 20 1 4 .
F o r p u rp oses of ch a pte r 3 of t h e I nte rn a l Reve n u e Co d e , a Fo rm W- 8 B E N (rev i s i o n d ate
Feb r u a r
y 2 0 0 6) p rovid e d to a w i th h o l d i n g ag e nt by a n ent i ty b efo re J a n u a r
y 1 , 20 1 5 will
rem a i n va l id u nti l th e fo rm ' s va l i d ity expi res u n d e r Trea s u r
y R eg u l ati o ns se cti o n 1 . 1 4 4 1 - 1 (e)
(4) ( i i ) .
F o r p u rp o se s of c h a pte r 4 of th e I nte rn a l R eve n u e C od e , a Fo rm W-8 B E N ( rev i s io n d ate
F e b ru ary 20 0 6) p rovi d ed to a w i th h o l d i n g ag en t by a n e n t i ty b efo re J a n u a r
y 1 , 20 1 5 is and
wi l l rem a i n va l i d to t h e exte nt p e rm i tted i n T rea s u r
y Reg u l at i o n s se ct i o n 1 . 1 4 7 1 - 3 (d ) ( 1 )
(describi n g th e a l l owa n ce for u se of a "pre-FATCA Form W-8") . See al so Trea su r
y
Reg u l ati o n s sect i on 1 . 1 47 1 -2T (a) (4) (i i ) (d e sc r i bi ng a t ra n s iti on a l exce pt i o n to w i th h ol d i n g fo r
ce rta i n paym e nts m ad e with res pe ct to a preexi st i ng o b l i g atio n ) .
A wi th h o ld i n g a g e nt m ay re q uest t h at yo u p rovid e a F o rm W- 8 B E N (revi si o n d ate Fe bru a r
y
2006) before J a n ua r
y 1 , 20 1 5. T he F orm W-8B E N (revi si o n date Februa r
y 2006) ca n be
fou n d on i rs. gov i n th e Form s a n d P u bli cati on s secti on , unde r th e " Pri or Yea r Forms" ta b , by
sea rch i n g th e cu m u l ative l i st of form s po ste d th e re fo r th e term " Fo rm W- 8" . I t d o es n ot
refl ect t h e ch a n g es m ad e by FATCA .
o, W- 8B EN- E
{ Fe b ru a ry 2 0 1 4}
De part m ent o f t
h e Trea s u ry
C e rt i fi c ate of St at us of B e n efi c i a l Ow n e r fo r
U• Fonrited
States Ta x With hol d i ng a nd Re po rt ing ( Entiti es) J
u s e by en ti ti es, I n d ivi du als m u st u se Fo rm W*8B E N , • Secti on refe rences are to th e In ternal R even ue Code .
I n t er
n al Reve n ue Servi ce
• Give this form to the withholding age nt or paye r. Do not send to the IRS.
D O N OT u s e th i s fo rm fo r =
• U . S. entity o r U .S, citizen or resident
• A foreig n i nd ividual . . . . .
• A foreig n ind ividual or entity cl aim ing
(u nress clai ming treaty ben efits) . .
.
.
that
.
. . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .
income is effectively con nected with the conduct
. . . . . . . . . . . . . . .
. . . . . .
. . . . . .
of trade or business
. . . . . .
. .
. .
wi th i n
. .
OM 8 N o+ 1 5 4 5 1 62 1
I
• I n fo rm a ti o n a b o ut Form W-S B E N - E a n d i ts s e p a ra te i n st r u ct i o n s i s at w wz. irs+go v/form wSbe n e.
I
.
.
the
.
I n st ea d u s e Fo rm ;
. .
. .
U .S.
. .
. . . . . W-9
W-SB EN (I nd ivid ual)
.
.
. W-SECI
A f reign p
o rtnership' a f reig n sim pl e trust` r a f reign granto r trust (un ess c aimlng treaty bene ts) (see i nstructi n s f r excepti n s)
.
.
. W-8 1 MY
• A foreign gover
n m ent, intemaPonal organization, foreign central bank of i ssu e, foreign tax-exempt organ ization , foreign pdvate
fo und atio n, or govern ment of a U.S. possession claiming that in come is ef
fectively connected U .S. income or that is clai ming
the applicabi li ty of section(s) 1 t 5(2), 50 1 (c) , 892, 895 , or 1 443 (b) (un less claiming treaty benefits) (see i nstructions) . . . .
• Any person acti ng as an intermediary . . . . . . .
I dentifi cat i o n of Be n efi c i a l Ow n er
II : l I II
1
.
.
.
.
.
.
.
.
.
.
N ame of organization th at is the benefici al owner
.
.
.
.
.
.
.
.
.
Name of disregarded entity receiving the payment (if applicable)
4
Chapter 3 Status (entity type) (M ust check one box only):
] Simple trust
[
] Grantor trust
[
] Central Bank of I ssue
[
] Tax-exem pt o rganization
[
] Corporation
[
[ Complex trust
]
] Private fo u ndation
[
[ Disregarded entit
]
y
] Estate
[
If you entered di sreg ard ed entity, par
t nership , sim pl e trust, or g ra ntor tr
u st above, is the entity a hybrid making a treaty
cl aim? If " Yes u complete Par I I1 .
Re por
t i ng I GA FF I ot he r than a reg iste red d ee med -com pl i an t FF I
or participating FFI).
[
]
]
[
]
[
]
[
Part icipating FFI .
Reporti ng Model 1 FF I .
Reporti ng Model 2 FFI .
Reg istered deem ed -com pl iant FFI (other than a report ing Model 1
F F I o r s po n so re d F F I t h at h a s n o t o b ta i n e
d a G I I N) .
[ Spon sored FFI that has not obtai ned a G I I N . Complete Part IV.
]
] Cert ified deemed- complia nt non re
[
g i stering local bank. Compl ete
Pa rt V .
] Cert ified deemed- complia nt FFI with only low-value acco unts.
[
C om p l ete Pa r
t VI .
] Certified deemed compliant spon sored , closely herd investment
[
veh icle. Co mplete Par
t VI I .
] Cedifi ed deemed-compliant l i mite
[
d l ife debt i nvest ment entity.
Compl ete Par
t VI I I .
] Certified d eemed-compliant investment advisers a nd i nvestment
[
managers, Complete Part IX.
[ Own er- docu mente
]
d FFI . Co mplete Part X.
] Restricted d istri butor. Complete Part XI.
[
. W 81MY
[ Part nership
]
] Govern ment
[
] Yes
[
] No
[
] Nonreporti e
[
g I GA FFI (i ncl uding an FFI treated as a registered
d eem ed -compl iant F F] u nd er an a ppl icabl e M o del 2 I GA).
Co m p lete Pa r
t XI I .
] Foreign govern ment, governm ent of a U .S. possession , or foreign
[
ce ntra l ba nk of issue . C om plete P a rt X I I I .
[
]
]
[
]
[
]
[
]
[
]
[
]
[
International organization . Co mplete Part XIV.
Exempt retirement plans. Com plete Part XV.
Entity wholly owned by exempt benefi cial owners. Compl ete Part XV].
Territory financial institu tion. Complete Part XVI L
Nonfinancial g roup entity. Complete Part XVI II ,
Excepted nonfin ancia l start-up company. Complete Part XIX.
Excepte
d nonfin ancial entit
y in liq uidation or bankr
u ptcy.
Comp lete P art XX .
[ 50 1 (c) organization . Complete Part XXh
]
] N onprofit organ izatio n. Complete Part XXI I .
[
] Publ icly traded N FF E or N FFE aff il iate of a publ icly traded
[
corporation , Complete Par
t XXI I I .
[
]
]
[
]
[
]
[
]
[
xcepted territor
E
y N FFE . Com plete Part XXIV.
Active NFFE. Com plete Pa rt XXV.
Passive NFFE . Complete Part XXVI .
Excepted inter-aff i li ate FFI. Complete Part XXVI ] .
Direct reporti ng NFFE .
] Spon sored d irect reporti ng N FFE. Co mplete Part XXVI I I .
[
Permanent residence add ress (street, apt . or su ite no,, or ru ral route). Do not u se a P.O. b ox or i n-care-of address (other than a registered address).
Te getthof
f stra sse 1
Cit
y or town , state or province. I nclude postal cod e where appropriate.
Countr
y
1 01 5 Vien na
Au s tri a
M alti ng address (i f dif
f erent from above)
Cit
y or tovm , state or province. I nclude postal code where appropri ate.
8
.
Chapter 4 Status (FATCA status) (M ust ch eck one box o nly u nless otherwise i ndicated). (See instructions for details a nd com plete the
ce rtifi c ation be low fo r the e ntity ' s applicable statu s).
] N onparticipating FFI (includ in g a l imited FF[ er an FFI related to a
[
7
.
Au stri a
3
6
W-SECI or W-SEXP
.
2 Country of incorporation or organization
R a i ffe i s e n C e n t ro b a n k A G
5
.
U .S. taxpayer identifi cation number {TIN), if required
9a [
] GIIN
2 8 C W N 4 O O O 1 3 M E 04 0
Countr
y
b [
] Foreig n TI N
1 0 Referen ce n u mber(s) (s ee i n st rd c ti on s)
AT U 1 5 3 5 5 0 5
N ote. Pl ease complete rem ai nd er of t h e fo rm i n c t ud ing sig n i ng t he form i n Part XXI X.
For Paperwork Re d uction Act Notice, see sepa rate instructions,
Cat. No. 59689N
Fern] W-SB E N - E (2-20 1 4)
Form W-SBEN -E (2 20 1 4)
Pane 2
D isre g a rd ed E ntity o r B ra n c h Rece ivi n g Paym e nt. (Com pt ete o n ly if d isregard e d enti ty or branch of an
F F I i n a count ry oth er t h an t h e F F I ' s co u ntry of resi d en ce.)
P a rt I I
11
Ch apter 4 Status (FATCA status) of disrega rded entity or branch receiving paym ent
12
Add ress of d isrega rde
d entity or bra nch (street, apt. or suite no., or ru ral route). Do not use a P.O, box or in-ca re-of address (other than a
reg istered address).
[ Lim ited Branch .
]
] Participati ng FFI .
[
[ Reporting M odel 1 FFI .
]
] Report ing M odel 2 FFI .
[
] U .S . Bra nch.
[
City or town, state or province. I nclude postal code where appropriate.
Co u nt ry
13
G I I N (if a ny)
= '.J
14
=ll=
a
C l a i m of Ta x Treaty Be n efits (if ap p l i cab l e) . (For c h apte r 3 pu rposes on ly)
I certify that (ch eck all th at apply):
] The benefi cial own er i s a resident of _ A. _u.s_t_r_i_a_ . . . . . ..... . . . . . .
[
treaty between the Unite
d States and that cou ntr
y.
. . . . ..... .. . . . . . . within the meani ng of the income tax
]T
[
h e beneficial owner derives the item (or items) of income for wh ich the treaty ben efits are clai me
d , an d , if appl icable, meets the
c
] The benefi cial owner is claim ing treaty ben efits for divid ends received from a forei g n corporation or interest from a U.S. trade or business
[
1s
b
requirements of the treat
y provisio n deali ng with l im itation on be nefi ts (se e instructi ons) .
of a foreign corporation and meets qual ified resident status (see instructions).
Special rates an d conditi ons (if applicabl e - see instructions) : Th e beneficial owner is clai ming the provisions of Article . . . . ... .
of the treaty identifi e
d on l in e 1 4a above to claim a .... . . . . . . % rate of withhold ing on (spe
c ify typ e of i ncome): . . . ..... . . .
Explain the reasons the benefi cial owner meets the terms of the treaty art icle: . . . . . . . . . . . . . . . . . . . . . . . . .... . .. . . . . . . .. . .. . . . . . . . . . . ..... . . . .. .
II '
| LT
M
.
. ...
.•
.
Sp o n sore d FFI That H as N ot O bta ine d a G I I N
16
Nam e of sponsoring entity:
17
C h e ck wh i c h eve r box a p p l i es ,
] I cert ify that th e entity identified in Part I :
[
• I s an FFI solely because it is an investment entit
y;
• I s not a QI , WP, or WT; and
• Has agreed with th e entit
y identified above (that is not a nonpar
t icipating FF I) to act as the sponse
d ng entity for this entity.
] I certif
[
y that th e entity identified in Part I :
• I s a co ntrol le
d foreign corpo ration as defined in section 957(a);
• I s n o t a Q I , WP , o r WT;
• Is whol ly owned, d irectly or i ndi rectly, by the U .S. fi nancial i nstitution identified above that ag rees to act as t he spo nsori ng ent ity for this
e ntity ; an d
• Shares a co m mon electroni
c accou nt system with the sponsori ng entity (identified above) that enabl es the spo nsori ng entity to identif
y al l
account holders a n d payees of the entity and to access all account and custom er i nfo rm ation maintai ned by the entity i ncl udi ng, but not
li mited to, customer i dentific ation information, c u stomer docu mentafi on, account balance, and al l payments mad e to acco unt holders o r
pay e es .
i .,
18
iLv=m
Certifi e d De e me d- Com p l ia nt N on re g i ste ri ng Lo c a l Ba n k
] I cert ify that th e FFI ide ntifie
[
d i n Part I :
• Operates and is l icen sed solely as a bank or credit u nio n (or sim itar cooperative credit organization operate
d without profit) in its countr
y of
i ncorpo ration o r o rg an i zat io n;
• Engages pri marily in the business of receiving deposits from and making loans to, wit h respe ct to a bank, retai l cu stomers unrelated to such
bank and, with resp ect to a credit union o r simi lar cooperative credit org anization, members, provid ed that n o mem ber has a g reater than five
percent i nterest in such credit uni on or cooperative cre
d it org anization;
• Does not so lic it account holders o utsid e its cou n tr
y of org an i zat i on;
• Has no fixed place of business outside such cou ntry (for this pu rpose, a fixed place of busin ess does not inc l ude a location t hat i s not
advertise
d to the public and fro m which the FFI perfo rm s solely administrative support function s);
• Has no more tha n $ 1 75 mill ion i n assets on its balance sheet and, if it is a mem ber of an expanded affi li ated gro up, the group has no m ore
t h a n $5 00 m i l l i o n i n tot a l asset s o n i ts co n s o l i d ate
d or combine
d b a l a nc e sh e et s ; a n d
• Does not have any member of its expanded affi l iated gro up that is a foreig n financial i nstitution , other than a foreig n if nancial institution that
i s in corporate
d or organized in the same countr
y as th e FFI id entified in Pa rt I an d that meets the req ui re ments set for
t h in this Part V.
Form W-8 BE N - E (2-201 4)
Form W 8Ei E N E (2 20 1 4)
II .. rl &Vl ll
Cert ifie d De e m e d - C o m p l i a nt F FI w ith O n ly Low-Va l ue Ac cou nts
19
] I certify that th e FR ide ntifi ed in Part I :
[
Page 3
• Is not eng aged pdmarily in the business of investing, reinvesting , or trad ing in sece
d ties, partn ership i nterests, com mod ities, notional
pri nci pal contracts, insurance or annuity contracts, or any interest (including a futu res or fo rward contract or optio n) in such secu rity,
par
t nership i nterest, commodit
y , notional principal contract, insurance contract or an nuity contract;
• No fin ancial acc ou nt maintai ned by the FFI or any mem ber of its ex p an de d a ffil iated g ro u p, if any , h as a bal ance or val u e i n exce
ss of
$50,000 (as determ ined after applyi ng appl icable account aggregatio n rul es); and
• N either the FFI nor the entire expan ded affil iated g rou p, if any, of the FFI , have more than $,.5 0 mi l lion in assets on its consol idated or
co mb ined bal ance s heet as of the end of its mo st recent acco un ting year.
l ',, 11 |tl l l
20
21
Certifie d De e m e d - Co m p l i a nt Sp o n so red, C l o s e ly H e l d I nvestm e nt Veh ic l e
Nam e of spon sogng entity:
] I certify that the entity identified i n Part I :
[
• Is a n F FI su
t ely because it is an i nvestment entity descri be d i n § 1 . 1 4 71 - 5(e) (4) ;
• I s n ot a Q I , W P , o r WT;
• H as a con trac tual relationsh ip w ith the above iden ti fied spo nso ri ng en t ity t ha t ag rees to fulfi ll al l d u e d i l ig enc e, wit hh ol di ng, an d repo rt i ng
re spo n s ibi l ities of a par
t icipating FF I on beha lf of this e nti t
y ; a nd
• Twenty or fewer individuals own all of th e debt a nd equ it
y interests in the entity (d is regard ing debt i nterests owned by U . S. financial
i nstitu tio ns , p ar
t i c ipating F F Is, reg istere
d d eem ed-com pl ian t F F I s, an d cert ifi e d d ee m e
d -c om p l ian t F FI s and equ i t
y i nterests ow ne d by an
entity if that entity owns 1 00 percent of the e
q uit
y interests in the FFI and is itself a sponsored FFI).
I -, l" itl l l l
C er
t ifi e d De e me d - C o m pl ia nt Li m ite d Life D e bt I nvestm e nt Ent ity
22
] I cert ify that the eu
[
t ity identified in Part fi
• Was i n ex i ste n ce a s of J a n u a ry 1 7 , 2 0 1 3 ;
• I ssu ed al l cl asses of its debt or eq u ity interests to i nvestors on or before January 1 7, 201 3, pursuant to a trust in dentu re or similar agreement; a nd
• I s ce r
t ifi ed dee me
d -compl ian t bec au se it satisfi es th e req u i rem en ts to be tre ate
d as a l i mi te d li fe d e bt i nvest m en t enti ty (s uch as t h e
restdction s with respect to its assets and oth er req ui rements u nder § 1 .1 471 -5(f)(2)(iv)).
m ,., r=i ):l
Certifi e d De e m e d- C o m p l i a nt I nvest m ent Ad v i sors a n d I nvestm ent M a n a gers
23
] I cert ify that th e entity identified i n Part h
[
• I s a fi nanc i al i nst itutio n solely bec ause it i s a n i nve
s tment en tit
y desc ri bed i n §1 . 1 4 71 - 5(e) {4)(i)(A) ; a nd
• D o es n o t m a i nt ai n f i n a n c i a l ac c o u n ts .
II ". R I,I
Own e r- Do cu m e nte d F FI
N ote. This statu s on ly appli es if the U .S. financ ial instituti o n or pad ici p ating FF I to wh i ch thi s form is gi ve n has ag ree d that i t wil l t reat t he F FI as a n
owner-docum ented FFI (see i nstructio ns for eli g ibil ity re
q uirements). I n addition , th e FFI mu st make th e cer
t ifications below.
24a
] (Al l own er-docu mented F FIs check here) I cert ify that the FFI identi fied i n Part h
[
• Do es no t act a s an i n te rm e
d iar
y;
• Does not acc ep t d eposits i n the ordinary cou rs e of a bank ing o r si m il ar b u s i ne
s s;
• D oes no t ho ld , a s a su bs ta ntial po r
t ion of its bu siness , fi n anc ia l assets for the acco un t of o the rs;
• ]s not an i nsu rance company (or the holding company of an i nsurance company) that i ssu es or is oblig ated to m ake payments with respect to
a fi n an c i al a cc o u n t ;
• I s not owned by or in an expanded affili ated g roup with an ent ity that accepts depos its in the o rd ina r
y co urse of a banking or si mi lar
bu si ness , ho l ds, a s a s u bsta ntial por
t io n of its bus iness , fi n anc i al assets fo r the acc ou nt of oth ers, o r i s an i nsu ranc e co mpany (o r t he h old ing
company of an insurance com pany) th at i ssu es or is obligated to make payments with resp ect to a fina ncial acco unt; and
• D oes not ma in tain a fina nc ial accou nt for any no npa rticipati ng F F I .
Form W-8BE N - E (2-201 4)
Fr
o m W 8BEN-E (2-20 1 4)
II '.h'Ti J:l
Page 4
O wne r- Do cu m e nte d F FI (continued)
C h e c k b ox 24b o r 24 c, wh i c h eve r a p pl i e s .
b
] I certify that th e FFI identifi ed in Part h
[
• H as provided, or wi ll provide, an F FI owner repodi ng statement that contains:
• The name, address, TI N (if any), chapter 4 status, and type of docum entatio n p rovided (if required) of every i ndividual and specifie
d U .S .
person that owns a direct or indirect equity interest in the owner-docum ented FFI (looking th rough al l entities other than sp ecified U .S .
p erso ns);
• The nam e, address, TIN (if any), ch apter 4 status, and type of docu mentation p rovided (i f required
) of ever
y indivi du al and specified U .S.
perso n that owns a debt interest in the owne r-documented FFI (i ncluding any indirect debt i nterest , wh ich incl udes debt interests in any
entity that directly or i ndi rectly owns th e payee o r any d irect or i ndirect equit
y interest i n a debt holder of the payee) that constitutes a
fi n ancial accou nt i n excess of $50,050 (d is regarding al l such debt i nterests owned by par
t icipating FFI s, registered deeme
d -com pl iant FFI s,
cert ifi ed deeme
d -compliant FFI s, excepted N FFEs, exem pt ben eficial owners, or U .S. p erso ns othe r than specifie
d U . S. person s) ; a n d
c
• Any additional i nformation th e withhold ing agent req uests in order to fulfill its obligaSons with respect to th e entity.
[ I certify that th e FFl ide ntifi ed in Part I has provided , or wil l provide, an au ditor' s letter, sig ned within four years of the date of payment ,
]
from an indep endent accou nting fi rm or l egal representative with a location i n the United States stating that the fi rm or representative has
reviewed the FF I 's documentation with respect to all of its own ers and debt holders identified in §1 .1 47 1 -3(d
) (6)(i v){A)(2), and that the FFI
meets all the req ui re ments to be an owner doc um ented FFI . The F FI identified i n Part I has also provided, or wil l provid e, an FFI owner
reporting statem ent of its owners th at are sp ecified U .S. persons and Form(s) W-9 , with appl icable waivers.
C h e c k b ox 24 d i f a p p l i c a b l e,
d
II ".,]
] I cert ify that the entit
[
y identified in line 1 i s a trust that does not have any conti ngent ben eficiaries or desig nated classes with u nidentifie
d
b en e fi c i a ri es .
D:4 II
25a
Res tri cte d D i st ri b utor
] (Al l restri cted distributo rs check here) ] cert i fy that the entity identifi ed in Part I :
[
• Operates as a d istribu tor with respect to debt or equity inte rests of th e restdcted fund with resp ect to which this form is furnish e
d;
• Provides i nvestment services to at least 30 cu stom ers un related to each other and less than half of its customers are related to each other;,
• I s req uired to perf orm AM L due di ligen ce p roced ures unde r the anti-mo ney launde ring laws of its cou ntr
y of organization (which is an FATF
co mplia nt j uri sdiction);
• Operates solely i n its countr
y of incorporatio n or orga nizat ion, has no fixed place of business outside of that cou ntry, and has the sam e
cou ntr
y of inco rporation or organization as all members of its affi liated g rou p, if any;
• Do es not sol icit custo mers outside i ts cou ntr
y of incorporation o r organization ;
• H as n o more than $ 1 75 mi llion i n total assets u nder management and no more than $7 mi llion in g ross revenue on its income statement for
t h e m o st re c e nt acco u n t i ng year ;
• Is not a m em ber of an ex panded affi li ated g rou p that h as more than $500 mi l lion i n total assets und er management or more than $20 m il l ion
in g ross revenue for its most recent accounti ng year on a co mbined or consolidate
d incom e statement; and
• Does not d istribute any debt or secu dties of the restri cted fund to specifie
d U.S . perso ns , passive N FFEs with o ne or mo re substantial U .S .
owne rs , o r n on pa rtic ip
o ting FF Is.
Ch eck box 25b o r 25c, whichever a pplie s.
I furt her certif
y that with resp ect to all sales of d ebt or equity interests i n th e restri cted fund wi th respect to which this form is fu rnished that a re made
after December 3 1 , 20 1 t , the entity identi5ed in Par
t I:
b
] H as been bound by a distri bution agreement that contai ned a general prohibition on the sale of debt or securi ties to U .S. entiti es and U.S.
[
c
] I s currently boun d by a distri bution agreement that contai ns a proh ibition e n th e sale of debt or securi ties to any specified U.S. person,
[
passive N FFE with on e or more substantial U .S. owners, or no npart icip
o ting FF I a nd, for al l sal es made pdor to th e time th at such a
resident individuals and is currently bou nd by a distri bution ag reem ent that contain s a prohibition of the sale of d ebt or securiti es to any
spe
c ified U . S. person, passiv e N FFE with one or more substantial U .S. owners, o r nonpart icipati ng FFI .
restdction was i nclud e
d in its di stri bution ag reement, has revi ewed all accou nts relate
d to such sal es in accordance with the procedures
identified in §1 .1 47 1 -4(c) applicable to preexisti ng accounts and has redeemed or retired any, o r caused the restri cted fun d to transfer the
sece
d ges to a d istributor that i s a padicipati ng FFI or rep
o rting Model 1 FF I securi ties which were sold to specifie
d U .S. persons, passive
N F F Es wi th o ne o r more su bst antial U .S. ow ners, or non pa rtic i pa tin g FF I s .
II "., 'i D:( l ll
N onrep ort in g I GA FFI
26
] I cert ify that th e entity id entified in Part I :
[
• M eets the requirements to be considered a nonreport i g
e financial institution pu rsuant to an applicable ]GA between the U nite
d States and
• I s treate
d as a
und e r the provisions of th e applicable IGA (see instructions) ; a n d
• I f you are an F FI treated as a reg istered deem ed -com pl iant F FI under an appl icable Model 2 IGA, provide your GI I N :
Form W-8B E N - E (2-20 1 4)
Form W-8BEN- E (2-201 4)
Page 5
I '..h D:4 1 1 l
Fore ig n G overn me nt, Gove rn m e n t of a U .S. Possess io n, or Foreig n Centra l B a n k of Issu e
27
] I certify that the entity identified in Part I is the beneficia l owner of the payment an d is not e ngaged in commercial fi nanc ial activities of a
[
type engage
d i n by an i nsu rance company, custodial institution, or depository insti tution with respect to the paym ents, accounts, o r
obligations for wh ich this form is s ubmitted (except as perm itted in § 1 . 1 47 1 - 6(h)(2)).
I .. IJ,',l kvl
I nte rn at i on a l O rg a n izatio n
C h e c k b ox 28a o r 28b, wh i c h eve r a p p l i e s ,
28a
b
[ I cert ify that th e entity identified i n Part I is an international o rgan ization d escri b e
]
d [n section 7 70 1 (a)(1 8).
] I cert ify that th e e ntit
[
y identified i n Part I :
• I s compri se
d pd mad ly o f fo reig n gove rn ments;
• Is recog n ized as an i ntergovernmental o r su pra national o rgan izat ion u n der a fo rei g n l aw sim i lar to th e I nt er
n a ti ona l Org an izati ons I m mu n i t ies
Ac t ;
• The b e ne fi t of t h e entit
y 's i ncome do es not i nu re to any p dvate p erson;
• is the ben efici al owner of th e paym ent an d is not engaged i n comm ercial fin anci al activi ti es of a type engaged i n by an insurance co mpany,
cu stod i al ins ti tuti o n , o r d epo sitory ins tif
u t[on with res pec t t o t he p aym en ts, acco u nt s, or o bl ig ations for wh i ch thi s fo rm i s sub m it ted (exce pt as
perm itted i n § 1 . 1 471 - 6(h)(2)).
l =., l J;tvl
Exe m pt Ret ire m e nt Pl an s
C h e c k b o x 2 9a , b , c , d , e , o r f, w h ic h eve r a pp l i e s .
29a
] I certif
[
y that the entity [dentlfied i n Part I :
• I s estab lis hed i n a country vd th w h ich the U nite
d States has an i nco me tax treaty i n force (see Par
t I I I if cl ai mi ng t reat
y ben efits) ;
• Is o perate
d pri nc ipal ly to ad ministe r or provide pensi on or reti re m en t ben efits ; a nd
• Is entitled to treaty benefits on i ncome that the fun d derives from U.S . sources (or would be ent itl e
d to benefits if it dedved any such income)
as a resid en t of the oth e r cou ntr
y w hich sa t isfi es a ny ap p lic able l im itati on o n be nefits req ui rem en t .
b
] I cert ify that the entity id e nti fied in Part I :
[
• Is organized for the provision of retirement, disabi lity, or death benefits (or any com bin a0on thereof) to benefici aries that are former
emplo yees of one or more em plo yers in consideration for se rvices ren d ered ;
• No sing le bene fi ciary has a dg ht to mo re than 5% of the F FI 's assets ;
• I s su bject to govern ment reg ulation and provides ann ual information reporting about its ben eficiari es to the releva nt tax authori ties in the
cou ntry in whi c h the fu n d is establ i shed or operated ; a n d
• I s g ene ral ly exempt from tax o n investmen t i ncome und er t he l aws of th e cou n tr
y in wh i ch it i s establ i sh e
d o r o perate s d ue to its st at us a s
a re ti re ment or pen sion pl an;
• Receive
s at least 50 % of its total con lri butions from sponsori ng employers (disregarding tra nsfers of assets from oth er ptans described in
t his par
t , retirem en t and pen sion accou nts described i n an ap pl i cab le M o det 1 or M od e l 2 IGA, o th er reti re m ent fund s d escd be d i n a n
applicable Model 1 or M odel 2 IGA, or accounts descdbed in §1 .1 47 1 -5(b)(2)0) (A));
• E ith er d oe s not permi t or pen al izes d istrib utio ns or withd rawa l s m ad e before the occu rre nce o f sp ec ifi ed events rel at e
d to ret irem en t,
disabi lit
y , or death (except rollover d istdbutio ns to accou nts d escri bed in §1 . 1 471 -5(b)(2) (A) (referri ng to reti rement and pen sion accou nts),
to retirement and pension accou nts described i n an appl icable Mod el 1 or Model 2 I GA, or to other retirement funds d escri bed i n this part or
in an ap p licab le M odet 1 o r Model 2 IG A); or
c
• Li mits contdbutions by employees to the fund by reference to earn ed inco me of the emp loyee or may n ot exceed $50,000 an nual ly.
] 1 cert if
[
y that the entity identified in Part ] :
• I s organize
d fo r the provision of retirem ent, disabi lit
y , or death benefits (or any combin ation thereof) to ben eficiari es that are form er
employee s of on e or mo re emp loye rs in consideratio n for services ren d ered ;
• H as fewe r tha n 50 par
t icip an ts;
• I s spo nsore
d by on e or more em ployers each of which is not a n investment entity or passive N F F E;
• Empt
h yee and employer contributions to the fu nd (disregardi ng transfers of assets from oth er plans descri bed i n this par
t , reti rement and
pens i on acc ou n ts d escri b ed i n an appl ica ble Mod e l 1 or Mo d e l 2 I GA, o r acc ou n ts d escr ibe d in §1 . 1 4 7 1 - 5 (b)(2) (i) (A)) are l i mi t ed by referen c e to
ea rne d income a n d com pen sation of th e e mployee, res p ect ive ly ;
• Participants that are not residents of the cou ntr
y in which the fu nd is establish ed o r operated are not entitl ed to more than 20 percent of the
fu n d 's assets ; a n d
• Is su bject to g overnm e nt reg ulation and p rovides an nu al i n form ati o n re po rti ng about its ben efici ad es to th e re l ev ant t ax a uth orit ies in t he
ca un tr
y i n whi ch the fun d is establi she d or operates .
d
e
] I cert if
[
y that the entity identified in Part I is form e
d p ursuant to a pen sion plan that wou ld m eet th e requirements of section 401 (a), oth er
than the req u i re me nt that the pl an h e fu n d ed by a tru st c reate
d o r organ iz e
d i n the United S tate
s.
] I cert if
[
y that the entity identified in Part I is establ ished exclusively to earn income for the ben efit of eri e or more retirem e nt funds
desc ribe d i n this par
t o r in an a ppl icab Ie Model 1 or M od el 2 I GA , acc o u n t s d escri bed i n § 1 . 1 4 71 -5 (b) (2) (i)(A) (referr
i ng to reti re m en t a n d
pens i on a ccou nts) , or reti rem e nt and pe nsio n accou nts desc ri be d i n a n appl ica bl e M o d e l 1 o r M ode l 2 IG A.
Form W-8 BEN - E (2-20 1 4)
Form W-8B E N -E (2-20 1 4)
Page 6
l ', 'l l:{vA
Exe m pt Reti re m ent P la ns (Cont i n u ed)
]
[ I certify that the entity identified in Part h
• I s establ ish ed and sponsored by a foreign governm e nt, international orga nizat ion , central bank of issue, or governme nt of a U .S. possession
(each as defined i n §1 . 1 471 -6) o r an exempt beneficial owner dese
d bed i n an applicable M odel 1 or Mod el 2 I GA to provid e reti rem ent,
d isab il it
y , or death benefits to be neficiari es or participants that are cu rrent or former employees of the sponsor (or persons desig nated by such
em p lo yees); or
• I s est abl ish e
d an d sponso red by a foreig n govern men t, interna tion a l org an i zati on , cen tral b an k of issue, o r g ove rn m e nt of a U .S . pos
s essi o n
(each as defi ned in § 1 . 1 471 - 6) or an exempt ben eficial owner d es cdbe d in an a p p li ca bl e M od e l 1 o r M o de l 2 I GA to prov
i de reti rem e n t ,
d isab il ity, o r death b ene fits to b en eficiari es or p ad icip an ts tha t are not c urrent or form e r e m plo yees of su ch spo nso r, b ut are i n co ns i dera tion
of personal services per
form ed for th e s ponsor.
I '..r |: VJ l
30
Entity Wh o l l y Own e d by Exem pt Be nefici a l Own ers
] I certify that the entity identified in Part h
[
• I s a n FF I sole ly b ecause it i s an investm ent en tity;
• Eac h d i rec t h old er of an eq uity interest in the investm ent entity i s an exe m pt ben ef ic i al o wne r d escri b ed i n § 1 . 1 4 71 - 6 or i n an a ppl icab le
M od e l 1 o r M od e l 2 I G A;
• Ea ch d irect ho lder of a d ebt interest in the investme nt en tity is eith e r a depos i to ry i n sti tut i on (w it h respect to a l o an m ad e to suc h e ntity) o r a n
exempt ben efi cia l owner descdbed i n §1 . 1 47 1 -6 or an a ppl icab l e M o d e] 1 o r M o del 2 I GA .
• H as provided an owner reporting statement that contains the n ame, add ress , TI N (if any), chapter 4 status, and a descdption of the type of
do cu m en tation provid ed to th e w ithh o ld i ng ag en t fo r ever
y p ers on that owns a d ebt i nterest co n s ti t uti ng a fi n anc i al acc o unt or d irect eq uity
i nte rest i n t h e e nt ity ; a n d
• H as provided documentation establ ish i ng that ever
y owner of the entity i s an entity describ ed in §1 . 1 471 -6(b), (c), (d), (e) , (f) and/or (g) without
reg ard to wh eth er suc h owners are beneficial owners.
I ',,F l,: VA l !
31
Te rritory Fi n a n c i al I nst itut i o n
] I cedify that the entity identified in Part I is a financial institution (other than an i nvestm e nt entity) that is incorporated or organized u nder
[
th e l aws o f a pos s essi o n of t h e U n i ted S tates .
I '.,'T= i,:tvJ I I I
32
Exce pte d N onfi n a n c ia l G ro u p Entity
] I cert if
[
y that th e enti ty id entified in Part h
• I s a hold ing comp a ny , treas u r
y center, or cap tive fi nanc e co m pany and su bs ta nti a l ly a l l of the enti ty 's act iviti es are fu nctio ns dese
dbed in
§1 . 1 471 -5(e)(5)(i )(C) through (E) ;
• I s a mem be r of a nonfinaneial group d escdbed i n §t .1 47 1 - 5 (e) (5)(i) (B) ;
• I s not a depositor
y or cu stodial institution (other than fo r m embe rs of the entit
y 's ex panded affil iated g roup) ; a nd
• Do es not fun ction (or hold itself out) as an investm ent fu nd , such as a private equity fund , ve ntu re capital fun d, leve raged buyout fu nd , or any
i nvestm ent vehicle wi th an i nvestment strategy to acq ui re or fu nd companies and then hold i nterests i n those com panies as capital assets for
i nv est m en t pu rpos es .
I'
33
D:q ):4
Exce pted N onf
i n a n c ia l Sta rt- U p C o m pa ny
] I cert if
[
y that the entity identified i n Part I :
• Was fo rmed on (or, i n the case of a n ew line of business, the date of board resoIution approving the new line of busin ess)
(date must be l ess than 24 months pdor to date of payment);
• I s not ye t op e rating a bus in ess and has no prior op erating histor
y or i s i nves t in g capi tal i n as sets with the i nt ent to o p erate a n ew l ine of
b u s i n es s ot h e r t h a n th at of a fi n a n c i al i n s t i t u ti o n o r p a ss ive N F F E ;
• I s i nvestin g capita l in to assets with the inten t to op erate a b usi ness ot he r t han that of a fi na nc ial i ns ti tut ion ; a nd
• Does not function (or hoTd itself out) as an investment fu nd , such as a pdvate equity fund , ventu re capital fu nd, leveraged buyeut fu nd , or any
invest ment veh icle whose purpose i s to acq ui re or fund compa n ies and t h e n h el d interests in t ho se co mpani es as capi tal assets for inves t men t pu rp
o se
s.
ii .' Rr'= i)'. :4
Exc e pte d N onfin anci a l E ntity i n Li q u i d atio n or Ba n k ru ptcy
34
] I co dif
[
y that the entity identified i n Part I :
• F i led a p l an o f l i quidation, fil ed a pla n of reorga n izati on , o r f
l ied for b an kruptcy o n
.
. .
.
.
.
.
.
.
.
.
.
.
.
. .
.
.
. .
.
.
.
.
.
.
.
.
. . .
. .
.
. . . . .
.
.
.
.
.
.
.
.
. .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
• D u dn g the pas t 5 yea rs h as not bee n eng ag ed in busi ness as a f
i nanci a l i nsti t u tion or acted as a pass ive N F F E;
• I s eithe r l iquidating o r em erg ing from a reorga n i zation or ban kru ptcy vJth t he i n tent to co n ti n ue or rec om m ence operati on s as a n onfi nanc ial
e n t i ty; a n d
• H a s, o r wil l provide , do cum en tary evide nce suc h as a ban kre ptcy fi l i ng o r ot h e r pub li c d ocu m e n tatio n t hat su ppor
t s i ts cl aim i f it rem a ins in
ban kru ptcy or liquidatio n for more than three years.
I IF D:*: i
35
50 1 (c) O rga n izat io n
] I cedify that th e entity identi fied i n Pad I is a 501 (c) o rganization that:
[
• H as b een issued a determ i na t ion lette r from the I RS t hat i s cu rre ntly i n effect co nc l u din g t hat the paye e is a sectio n 5 0 1 (c) o rgan izati o n t h at i s
d ated. . .
. . . . . .. ; or
• Has provid ed a copy of an opinion from U ,S , cou nsel certifying that the payee is a seclion 501 (c) organization (without regard to whether the
payee is a foreign p dvate fou n dation).
Form W-8B E N - E (2-20 1 4)
Form W-8BEN E (2 20 1 4)
I "., i ;$'.'t I I
Page 7
N o n - Profit Org a n izati o n
] I certify that th e entity identified in Part I is a non -profi t org anization that meets the fol lowing requi rements :
[
36
• The entity is establ ished and maintained in its country of residence exclusively for religious, charitable, sf
i enfi fic, artistic, cultural or educationa l pu rposes;
f
• The e ntity is exempt from inco me tax i n it s co u n try of re s i denc e;
• Th e e ntity has no shareholders or mem bers who have a propri etary or beneficial interest in its income or assets;
• N ei ther the appl icabTe laws of the entity 's cou ntry of residence nor the entity 's form ation docu ments permi t any income or assets of the entity
to be distdbuto
d to, or app lied for the b enefi t of, a private person or n on-chadtable entity other than p ursuant to the conduct of the entity 's
ch aritable activities or as payment of reason able compensation for ser vices rendered or payment representi ng the fai r ma rket va lu e of property
wh ich th e en tity h a s p u rch a sed; an d
• The applicable laws of the e nt ity 's countr
y of residence or the entity 's formation docu ments requ ire that, up( n the entity 's liquidation or
di ssolutio n, al l of its assets b e di stri buted to an entity that is a fo reig n governm ent, an integ ral part of a foreign government , a controlf
i d entity
f
of a foreig n governm ent, or a n other orga nizat ion that is described i n this Pa rt XXII o r escheats to the governm ent of the entity 's cou ntr
y of
res iden ce o r any polgi cal su bd ivis ion th ereof.
I '.. l D: :ql l l l
P u b l i c ly Tra de d N FFE or N FFE Af
f i l i ate of a P u b li cly Tra de d C orp orati o n
Check box 37a or 37b, wh ichever applies.
37a
] I cert ify that:
[
• The entity id entifi ed in Part I is a foreig n corporation that is not a financial i nstitution ; a n d
• The stock of such corpo ration is regu larly traded o n one or more establ ished secu rities markets, includ ing . . . . . .
(name one sec urities exch ange upon which the stock is reg u le
d y traded).
b
.. . . . . . . ... . . . . . . . . .....
] I cert if
[
y that:
•T
h e entity identifi ed in Par
t I is a foreig n corporation that is not a financial institution ;
• The ent ity identified i n Part I i s a mem ber of the sa me expan ded affi l iated g roup as an e ntit
y the stock of which i s regularl y traded on an
e s tab lish ed sec u rities marke t;
• The name of the entity, the stock of wh ich is regu la rly traded on an establ ished secu dges market, is . . . . . . . . . . . . . . . . . . .
•T
h e n ame of the secb
d fi es m arket on wh ich the stock is reg ularly traded is
I '.,.. ' i1..' ;( vA
38
. . . . . . . . . . . . . ; a nd
Excepte d Territory N F F E
] I certif
[
y that:
• The entity identi fied in Par
t I i s an entity that is organized in a possession of the United States;
• The en t ity iden tified i n Pa r
t I:
• Does not accept deposits in the ordi nary cou rse of a ba nki ng or similar business,
• Does not hold , as a substantial por
t ion of its business , financial assets for the acco unt of others , or
• Is not an insurance com pany (or the holding co mpany of an insurance company) that issues or is obligate
d to make paym e nts with resp ect
to a fi n a nci a l ac c o u n t ; a n d
• All of the owners of the entity identified i n Part I are bona fide residents of the possession in which the N FFE is organized or incorporated.
I"
I): : U
39
A ct ive N F FE
] I cert if
[
y that :
• Th e entity identifi ed i n Par
t I is a foreig n entit
y th at is not a financia l i nstitution;
• Less than 50 % of such enti t
y 's g ross income for th e preced i ng cal endar year is passive income; an d
• Less than 50 % of the assets h eld by such ent it
y are assets that produce or are held fo r the produ ction of passive i ncome (calcu lated as a
weighted averag e of th e perce ntage of passiv e assets measured q uart erl y) (see i nstructions for th e d efi nition of passive incom e) .
I"
D: : vA I
40a
P a ss i v e N F F E
] I cert if
[
y that the entity identified in Part I is a foreign ent it
y that is not a financial insti tution (other than an investment entit
y organized in a
possession of the United States) and is not cer
t if
y ing its status as a pubfi cly traded NFFE (or affiliate) , excepted territor
y N FFE, active
N FFE, direct repor
t ing N FF E, or sponsored d irect repor
t ing N FF E .
C h eck b ox 40b o r 4Oc , wh icheve r a p plie s.
b
c
] I fu rt her cert ify that the entity ide nlgie
[
q i n Part I has no substa ntial U .S. own ers, or
] I fudher cert ify that the entity identi fied in Part I has provided th e name, address, and Ti N of each substantial U.S. own er of the NFFE i n Pad XXX.
[
I ',, 11 11':$:tvA I I
41
Excepted I nte r-Af
f i l iate FFI
] I certgy that th e e ntit
[
y identified in Part I :
• [s a mem ber of an expanded af
i l i ated group;
f
• Does not m aintai n fi nancial accou nts (other than accounts m ai ntained fo r m embers of its expanded affi l iated group);
• Does not make withholdable paym ents to any person other than to mem bers of its expanded affi l iated g roup that are not l im ited FFIs or
l i m i te d b ra nc h es ;
• Does not b
e ld an accou nt (other than a deposi tor
y accou nt in the countr
y i n wh ich th e entity is operating to pay for expense
s) with or receive
payments from any withholding agent other than a mem ber of its expanded affiliated gro up ; an d
• Has not agreed to report under §1 . 1 47 1 -4 (d)(2) ii) (C) or olh erv se act as an agent for ch apter 4 pu rposes on beha]f of a ny fi nancial institu tion , including
a member of its e×panded aff
l iated g roup,
i
Form W' S B E N - E (2-20 1 4)
Form W-8BEN E (2 20 1 4)
I '., l:$: vJ I I I Spo n s ore d D i re ct R e p ort ing N FFE
42
48
I ",,
Page 8
Name of sponsoring entity:
] I certify that the entity id erltified in Part I ls a dkect relo ort ing N F FE that is s#onsored by the entity identified i n line 42 .
[
I:(,: KI
Ce r
t ifi c at i on
Under e
p nal t ies of perjury, I declare that I have examined the I nf
o rrnatlon on this form and to the best of my knowledge and berief it is true, cofreCh a
n d compFete. I fudb
er
cert i fy u nd er pena l t ies of p
e rj u ry that :
• The enti ty identified on line 1 of lhis form is the benefi cial owner of all the income to which this form relates, is using this form to certif
y its status f
o r chapter 4
pu rpose s , or i s a m e rc ha n t s u bm i tt l n g t h i s f
o rm f
o r pu rp oses e f sect i on 6050 W,
• Th e ent ity i dentifi ed on line 1 of thi s form i s not a U. S . p
e rson,
• The income to which thi s f
o rm rerates is: {a) not effeclivef
y con nected with the conduct of a trade or bu siness In the United States. (b} effectfvef
y connected but Is
not subject to tax under an income tax treaty, or (c) the partner's share or a parlnership's effectively connected income, an d
• For broker trar sactions or bader exchanges, the benefi cTal own er is ar exempt for
e ign person as defi n e
d in the instructions.
Fu rthermore, I authorize this for m to be provided to any withb
e lding agent that has control, receipt, or custody of the income of which the entity on line 1 ts the beneff
o [al
owner or any wit hh ordin g ag ent that can disbu rse or make payments of the f n come of which th e en tit y on l in e 1 is the ben efi ci al ow ner.
I a g re e t hat I wi l l s u b m i t a n ew fo rm wi th i n 8 0 d ays i f n y c
Si g n H ere
,
\
if ica ti o n o n i b is fo rm bec o me s i nco rre ct .
Anggl;
a ,G btlw i
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Sig tuu e o r d v duaJ a(J fo orlz cd to si g n for benefi cia l owner
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(
/ rll laf ,/............... .bate (-M M-[)-D-
] I certi fy th at I have th e capacity to sign for the entity identified on line 1 of this form ,
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1): : :1
S u bsta n ti a l U .S. Own ers of Pa ss ive N FFE
As required by Pa rt XXVI, provide the name, address, and TI N of each substa nt ial U.S . owner of the N FF E. Please see instructions for definition of
s u b sta n t i a l U . S . o w n e r .
N am e
Add ress
TI N
Form W-8B E N - E (2-201 4)
"